Session Type: Abstract Submissions (ACR)
Managing axial spondyloarthritis (aSpA) may be difficult because sometimes patients are not good responder to anti-TNF. We made the hypothesis that in certain patients, high disease activity could be due to associated fibromyalgia (FM). Indeed, some patients describe more widespread pain and more associated symptoms than others. The objective of this study was to analyse differences between aSpA patients (ASAS 2009) according to their meeting of the ACR 2010 FM criteria.
It was a prospective transversal observational study. 51 patients with aSpA satisfying the ASAS 2009 criteria were included during one year. All patients were treated with infliximab. Every patient filled once an auto-questionnaire with items of ACR 2010 FM criteria, Visual Analog Scale (VAS) for pain and global disease activity (GDA), BASDAI, BASFI, FIQ, HAQ, FACIT-13, SF-36 and First Score. We collected items of BASMI, numbers of tender joint (TJ), swollen joint, MASES score and number of Yunus tender points. Erythrocyte Sediment Rate (ESR) and C-reactive protein (CRP) levels and ASDAS score were collected.
Twenty-four patients (47%) met the FM ACR 2010 criteria (FM+). No difference between FM+ and FM- patients for age at inclusion, age at beginning of aSpA, number of infusion and interval between infusions of infliximab. Female proportion was higher in FM+ group (NS) (70% vs 48%; p=0.1). Compared to FM- patients, FM+ patients had higher TJ number (6.4 ± 7.6 vs 1.7 ± 3.5 p<0.0001), MASES (7.67 ± 3.88 vs 2.8 ± 4.08 p<0.0001), Yunus points number (8.75 ± 5.45 vs 3.19 ± 4.11; p<0.0001), Pain VAS (6.19 ± 1.88 vs 3.56 ± 2.74; p=0.0006), GDA VAS (6.25 ± 2.04 vs 3.39 ± 2.36; p<0.0001). BASMI, ESR and CRP levels did not differ between the groups. ASDAS-CRP was higher in FM+ patients (3.05 ± 0.85 vs 1.89 ± 0.66; p<0.0001). BASFI (56.1 ± 26.8 vs 31.5 ± 24.22 p=0.0012), FIQ (63.03 ± 16.25 vs 30.21 ± 17.7, p<0.0001), FACIT-13 (17.49 ± 6.45 vs 33.39 ± 11.44), mental SF-36 (33.19 ± 17.94 vs 62.77 ± 21.9, p<0.0001), physical SF-36 (29.89 ± 16.09 vs 55.05 ± 22.39, p<0.0001) and First score (4.70 ± 1.12 vs 2.41 ± 1.85, p<0.0001) were more severe in FM+ patients.
When we analysed by which arm of the ASAS 2009 criteria, patients were diagnosed with aSpA, we showed that 11% of FM- patients were diagnosed only by the HLAB27 arm compared to 37.5% in FM+ patients (p=0.046).
Patients with axial SpA (ASAS 2009) that fulfilled the FM ACR 2010 criteria were more severe in terms of pain, fatigue, quality of life, mental and physical function and SpA disease activity.
When disease activity is high, despite anti-TNF treatment, assessment of FM ACR 2010 criteria status should be useful to understand the reasons for lack of efficacy.
In a context of FM ACR 2010 criteria fulfilling, when SpA disease activity is high, physicians should consider diagnosis revision if only HLAB27 arm of ASAS 2009 aSpA criteria has been used to make the diagnosis.
A longitudinal study could be interesting in order to assess the benefit of anti-TNF in aSpa patients that also fulfils the FM ACR 2010 criteria before treatment introduction.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/meeting-the-acr-2010-fibromyalgia-criteria-worsens-disease-activity-and-quality-of-life-in-patients-with-axial-spondyloarthritis-treated-with-infliximab/